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1558071399
SHAWNTAE JACKSON
PORTLAND, OR
NPI
1558071399
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Former Name
SHAWNTAE COOPER
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2022-12-02
Last Update Date
2022-12-02
Business Address
SHAWNTAE JACKSON
2270 NW OVERTON ST
PORTLAND, OR 97210-2927
Phone number: 503-241-6051
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Mailing Address
SHAWNTAE JACKSON
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number:
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